Individual
MRS. KEISHA TAMARA SHAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
220 PARK AVE, BARBOURSVILLE, WV 25504-1544
(304) 360-6482
Mailing address
220 PARK AVE, BARBOURSVILLE, WV 25504-1544
(304) 360-6482
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
32060
WV
Other
Enumeration date
06/07/2012
Last updated
06/07/2012
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